-
[show abstract]
[hide abstract]
ABSTRACT: Gestational diabetes (GD) exposes mothers and infants to the risk of immediate and later adverse outcomes. Increased insulin resistance is a common feature of GD and obesity. Because of its critical role in regulating insulin sensitivity, resistin has been implicated in the physiopathology of GD. The aim of this study was to review the existing literature on the relationship between circulating maternal resistin levels and GD. Three electronic databases (MEDLINE, EMBASE, and LILACS) were searched for pertinent studies published from 2001 to 2012, without language restrictions. Eleven studies, with a total of 639 participants between 23 and 41 weeks of gestation, were included. The number of GD patients per study ranged from 11 to 81, with varying degrees of disease severity and several different GD diagnostic criteria. Mean concentrations of resistin varied widely both in control women (0.05-22.21ng/ml) and in GD patients (0.05-62.38ng/ml). We performed a meta-analysis including a total of 10 studies, and also subgroup analyses according to gestational age at sample collection (up to 32 and >33 weeks). The pooled absolute mean difference (WMD) in resistin levels was slightly lower in GD patients than in controls, but this did not reach statistical significance (WMD=-0.02, 95% CI -0.07 to 0.04). According to the data from the 11 studies analyzed, there was no association between circulating resistin levels and GD. However, this result should be interpreted with caution owing to the large heterogeneity amongst the existing published studies.
Journal of Reproductive Immunology 03/2013; 97(1):120-7. · 2.97 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: PROBLEM: Gestational diabetes mellitus (GDM) is an inflammatory condition that involves unbalanced cytokine production. We carried out a systematic review on the relationship between GDM and maternal circulating levels of cytokines in the 2nd/3rd trimesters. METHOD OF STUDY: Three electronic databases (MEDLINE, EMBASE and LILACS), were searched. Duplicate study selection, extraction and quality assessment was performed. RESULTS: Twenty-two studies with 1982 participants reporting levels of 9 cytokines (IL-1B, IL-2, IL-6, IL-10, IL-13, IL-18, IFN-G, TGF-B and TNF-A) were included. Most studies differed considerably in selection criteria, sampling and assay methods and in reporting their results. Consequently, only two studies could be pooled: TNF-A concentration was slightly higher in GDM than in control patients, although not significant (WMD = 0.45, 95% CI -0.34-1.23). CONCLUSIONS: New studies with well-defined, more homogeneous methodological parameters are needed to detect whether there are significant differences in circulating levels of cytokines in patients with GDM.
American Journal Of Reproductive Immunology 02/2013; · 2.17 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We assessed FAS and FAS-L gene polymorphisms and messenger RNA (mRNA) levels in patients with recurrent pregnancy loss (RPL). This case-control study compared 129 women with RPL with 235 healthy multiparous women (control group). Genomic DNA and total mRNA were extracted from whole blood, and polymorphisms genotyping was performed by polymerase chain reaction (PCR). Messenger RNA expression levels were analyzed by real-time PCR. Data were analyzed by chi-square and Fisher exact tests; P < .05 was considered significant. There were no significant differences in the FAS (670 A/G) genotype or allelic frequencies between the RPL and control groups. We found significant differences in the FAS-L (844 C/T) genotype and allelic frequencies between women with RPL and controls. Patients with RPL had significantly higher FAS-L expression. Our data suggest that FAS-L gene polymorphism is associated with increased susceptibility to RPL. Moreover, women with RPL seem to abnormally express FAS-FAS-L molecules.
Reproductive sciences (Thousand Oaks, Calif.) 02/2013; · 2.31 Impact Factor
-
Revista brasileira de ginecologia e obstetrićia: revista da Federação Brasileira das Sociedades de Ginecologia e Obstetrícia 11/2012; 34(11):485-7.
-
[show abstract]
[hide abstract]
ABSTRACT: Pregnancy affects both maternal and fetal metabolism, and even in non-diabetic women, it exerts a diabetogenic effect. Among pregnant women, 2% to 14% develop gestational diabetes. Pregnancy can also occur in women with preexisting diabetes, which may predispose the fetus to many alterations in organogenesis, restrict growth, and the mother, to some diabetes-related complications, such as retinopathy and nephropathy, or to acceleration of the course of these complications, if they are already present. Women with gestational diabetes generally start their treatment with diet and lifestyle changes; when these changes are not enough for optimal glycemic control, insulin therapy must then be considered. Women with type 2 diabetes using oral hypoglycemic agents are advised to change to insulin therapy. Those with preexisting type 1 diabetes should start intensive glycemic control. As basal insulin analogues have frequently been used off-label in pregnant women, there is a need to evaluate their safety and efficacy. The aim of this review is to report the use of both short- and long-acting insulin analogues during pregnancy and to enable clinicians, obstetricians, and endocrinologists to choose the best insulin treatment for their patients.
Arquivos brasileiros de endocrinologia e metabologia 10/2012; 56(7):405-14. · 0.68 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Pregnancy affects both the maternal and fetal metabolism and even in nondiabetic women exerts a diabetogenic effect. Among pregnant women, 2 to 17.8% develop gestational diabetes. Pregnancy can also occur in women with preexisting diabetes, that can predispose the fetus to many alterations in organogenesis, growth restriction and the mother to some diabetes-related complications like retinopathy and nephropathy or accelerate the course of these complications if they are already present. Women with gestational diabetes generally start their treatment with diet and lifestyle modification; when these changes fail in keeping an optimal glycemic control, then insulin therapy must be considered. Women with type 2 diabetes in use of oral hypoglycemic agents are advised to change to insulin therapy. Those with preexisting type 1 diabetes must start an intensive glycemic control, preferably before conception. All these procedures are performed aiming to keep glycemic levels normal or near-normal as possible to avoid the occurrence of adverse perinatal outcomes to the mother and to the fetus. The aim of this review is to reinforce the need to improve the knowledge on reproductive health of women with diabetes during gestation and to understand what are the reasons for them failing to attend for prepregnancy care programs, and to understand the underlying mechanisms of adverse fetal and maternal outcomes, which in turn may lead to strategies for its prevention.
Diabetology and Metabolic Syndrome 09/2012; 4(1):41. · 1.53 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: to evaluate the relationship between ductus venous (DV) and Doppler velocimetry in neonatal outcome in severe compromised preterm fetuses.
the study was designed as an observational and cross-sectional study with 52 premature neonates with brain sparing effect. The criteria of neonatal severe morbidity were: severe intraventricular hemorrhage (grades 3 or 4), retinopathy of prematurity (grade 3 or 4), cystic periventricular leukomalatia, bronchopneumo dysplasia and neonatal mortality. The fetuses were divided in two groups: group 0 - all the fetuses with ventricular systole/atrial contraction (S/A) in DV ratio values less them 3.4; group 1 - fetuses with values of S/A ratio greater than 3.4.
42% of fetuses showed abnormal S/A ratio in DV and 48% showed birth weight below percentile 3 for gestational age. There was no statistical significance comparing the 02 groups according to bronchopneumo dysplasia, retinopathy of prematurity (grade 3 or 4) and intraventricular hemorrhage (grade 3 or 4). Only one fetus presented cystic periventricular leukomalatia. We found statistically significant association between abnormal DV S/A ratio and neonatal mortality (CI 95%, 1.28 -38.22, p< 0.002).
our results suggest that abnormal DV blood flow detected by Doppler examination isn't associated with severe neonatal morbidity but with neonatal mortality.
Journal of prenatal medicine. 07/2012; 6(3):40-6.
-
[show abstract]
[hide abstract]
ABSTRACT: To assess the prevalence of bacterial vaginosis and to compare the accuracy of testing pH and KOH with the Nugent gradient, the gold standard for the diagnosis of bacterial vaginosis (BV) in asymptomatic and symptomatic pregnant women at low risk.
We conducted a cross-sectional study on 321 pregnant women with gestational age between 14 and 26 weeks, 218 of them asymptomatic and 103 with vaginal complaints suggestive of bacterial vaginosis. All women were assessed by the criteria of Nugent and subjected to the measurement of vaginal pH and to the 10% KOH test. The Kappa coefficient was used to evaluate the methods in terms of diagnostic agreement.
Most patients were adolescents (mean age 21.0 ± 5.6 years), nulliparous and mulattos. The prevalence of bacterial vaginosis was 33.3% as estimated by the pH and KOH method and 35.5% by the Nugent method. Excellent agreement of the methods was found among asymptomatic pregnant women, with 72.5% of them showing negative results to both tests, which resulted in a high Kappa coefficient (k=0.82). The group of symptomatic women showed 49.5% positivity to both diagnostic methods, with excellent agreement (k=0.74).
The prevalence of bacterial vaginosis determined by both the pH and KOH method and the Nugent score was high. The pH and KOH method can diagnose bacterial vaginosis as accurately as the Nugent criterion.
Revista brasileira de ginecologia e obstetrićia: revista da Federação Brasileira das Sociedades de Ginecologia e Obstetrícia 05/2012; 34(5):209-14.
-
[show abstract]
[hide abstract]
ABSTRACT: The relevance of gene polymorphisms in the development of unexplained recurrent spontaneous abortion is still unclear. Cytokines, angiogenic mediators, and hormones are involved in all stages of reproduction and pregnancy outcome. Impaired production and/or unbalanced ratios of these mediators have been implicated in the pathogenesis of unexplained recurrent spontaneous abortion. Functional polymorphism influence gene activity and therefore can interfere with the expression of mediators. Several studies have been carried out to evaluate the relationship between cytokines, angiogenic mediators, and hormones gene polymorphisms and unexplained recurrent spontaneous abortion. The results of these studies are mostly contradictory, and few significant associations have been identified. Up to present time, the evidence is insufficient to support the evaluation of cytokines, angiogenic mediators, and hormones gene polymorphism in routine workup in all cases of recurrent pregnancy loss, and these tests are not included in any of the major obstetric guidelines.
American Journal Of Reproductive Immunology 03/2012; 67(4):341-7. · 2.17 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Cancer is the second leading cause of death during the reproductive years, but the incidence during pregnancy is low. The incidence of cancer of the rectum during pregnancy is very rare (1:50,000 to 1:100,000 pregnancies). Usually, the symptoms of this type of cancer are nonspecific and sometimes they are confused with normal changes of pregnancy. The diagnosis of rectal cancer is usually made in the late stage of pregnancy. The treatment of this cancer involves surgery, chemotherapy and radiotherapy, but each type of treatment involves risks to the fetus and the pregnant woman. We present a case of a young primiparous woman who had a quick and bad evolution of an adenocarcinoma of the rectum diagnosed during pregnancy. This patient had extensive involvement of the liver with metastasis and she died two weeks after diagnosis. In this case, we present the clinical, radiological and pathology findings of this disease.
Case Reports in Oncology 01/2012; 5(1):208-11.
-
[show abstract]
[hide abstract]
ABSTRACT: Guillain-Barré syndrome is a rare neurological disease of progressive installation, usually following a previous acute infectious state, has a rare incidence, especially in pregnancy, and can induce major complications and high mortality risk. Its occurrence, after immunization to influenza during the last trimester pregnancy, has not been reported before. We presented a case of a 36-year-old pregnant woman that was immunized to H1N1 in the last trimester; 10 days later she developed shoulder and lumbar spine's pain, limbs weakness and facial paralysis with unfavorable clinical evolution and was submitted to intensive therapy care. We described clinical and obstetrical approach, pointing out peculiarities involved in this pathology in pregnancy.
Case reports in obstetrics and gynecology. 01/2012; 2012:323625.
-
[show abstract]
[hide abstract]
ABSTRACT: The number of women with gestational diabetes mellitus (GDM) is growing worldwide in parallel with the obesity epidemic. The diagnosis of GDM leads to substantial modifications in the daily routine of these women, and these adjustments could potentially affect their sexual function. There are no previous studies on the sexual function of patients with GDM.
The aim of this study was to investigate the sexual function of patients with GDM in comparison with healthy pregnant women at the same gestational age.
Brazilian women in the third trimester of pregnancy with and without GDM were invited to participate in this cross-sectional study while waiting for their antenatal care visits at a single public tertiary teaching institution between March and December 2010. The Brazilian version of the Female Sexual Function Index (FSFI) questionnaire was used to assess sexual function.
Desire, arousal, lubrication, orgasm, sexual satisfaction, and pain during and after coitus in the last 4 weeks, measured according to a standardized and validated questionnaire.
A total of 87 participants were enrolled (43 healthy women and 44 with GDM). There were no significant differences in the sociodemographic characteristics of both groups. The total FSFI scores of GDM patients was 21.0±9.59 compared with 22.3±9.17 for healthy women (P=0.523). Difficulty in desire was the most common sexual dysfunction symptom in both groups, being reported by 42% and 50% of GDM and healthy women, respectively (P=0.585).
The sexual function of Brazilian patients with GDM does not differ significantly from that of healthy pregnant women at the same gestational age.
Journal of Sexual Medicine 12/2011; 9(3):786-92. · 3.55 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Our study aimed to assess in vitro production of IL-10, IL-6, TNF-A, and adiponectin serum levels in pregnant women with and without gestational diabetes mellitus (GDM) and to investigate a possible association between GDM and IL-10-1082 A>G (rs1800896), IL-6-174 G>C (rs1800795), TNF-A-308 G>A (rs1800629), adiponectin +45 T>G (rs2241766), and adiponectin-11377 C>G (rs266729) gene polymorphisms.
This case-control study included 79 women with GDM and 169 healthy controls (C) grouped according to pre-pregnancy BMI. IL-10, IL-6, and TNF-A culture supernatant and adiponectin serum levels were assessed by ELISA. DNA genotype was performed by PCR-RFLP.
Adiponectin levels were significantly higher in C than GDM women, even within the same BMI category. Cytokines levels were similar between the groups. There were no associations between GDM and the analyzed gene polymorphisms.
Women with GDM have significantly lower adiponectin levels in the third trimester, regardless of BMI.
American Journal Of Reproductive Immunology 11/2011; 67(3):241-50. · 2.17 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study was to establish reference intervals for fetal ear length using 3-dimensional sonography in the rendering mode.
A cross-sectional study was conducted on 114 women from 19 weeks to 23 weeks 6 days of normal pregnancy. Fetal ear length measurement was performed in the rendering mode, obtained from 2-dimensional mode reconstruction. To determine the correlation between ear length and gestational age, scatterplots were constructed, and the Pearson correlation coefficient was calculated. Mean, median, SD, maximum, and minimum values and percentiles for each gestational age were calculated. To calculate the intraobserver reproducibility, we used the intraclass correlation coefficient.
The mean ear length ± SD increased from 14.43 ± 1.28 mm (range, 12.80-16.50 mm) in the 19th week of pregnancy to 19.72 ± 1.87 mm (range, 17.20-22.40 mm) in the 23rd week. Three-dimensional sonographic ear length measurements were correlated with gestational age, with the best adjustment represented by the following exponential equation: ear length = exp(1.215 × gestational age - 8.692) (R(2) = 0.423). The intraobserver reproducibility was excellent, resulting in an intraclass correlation coefficient of 0.967 (95% confidence interval, 0.939-0.982).
Reference intervals for fetal ear length using 3-dimensional sonography in the rendering mode from 19 weeks to 23 weeks 6 days of pregnancy were determined and proved reproducible.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 09/2011; 30(9):1185-90. · 1.25 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The incidence of gestational diabetes (GD) is rising worldwide, in parallel with obesity and type 2 diabetes. Obesity and GD are conditions that have in common a state of chronic, low-grade subclinical inflammation characterized by abnormal production of cytokines and mediators. Genetic polymorphisms may influence the production of inflammatory mediators and predispose to different disorders, including diabetes. The aim of this study was to review the existing literature on the relationship between inflammatory mediator gene polymorphisms and GD. The search in PubMed was restricted to articles published in English, from January 1990 to December 2010. Eight studies were included. These publications evaluated 13 different SNPs and six inflammatory mediators in the blood of women with GD. Gene polymorphisms related to leptin, mannose-binding lectin (MBL) and RAGE (receptor for advanced glycation end products) were individually evaluated in a single study each. Leptin and MBL plasma levels were also evaluated in two studies. The participants included in the studies were ethnically different, but matched with controls. Different criteria were adopted to select the participants. Seven of the eight studies included took into consideration the BMI of patients and controls. Due to the heterogeneity and limited number of studies on GD and inflammatory gene polymorphisms, we could not pool together any of the results or perform any additional analyses of the existing data. Since the existing findings come from isolated studies with mostly small sample sizes, there is a need for new, larger, properly designed studies of good methodological quality.
Journal of Reproductive Immunology 06/2011; 90(1):111-6. · 2.97 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To compare the sexual function of healthy adult pregnant women with that of gestational diabetes patients (GDM) in the third trimester.
This cross-sectional study enrolled two groups of women managed antenatal care clinics. Inclusion criteria were: maternal age .20 years, gestational age at least 28 weeks, being in a heterosexual relationship with the same partner for at least 6 months, and being able to read. We excluded women with a medical recommendation for sexual abstinence due to clinical or obstetric disorders; hypertension controlled through medications; pregnancy resulting from rape; absent or sexually unavailable partner in the last month; hospital admission in the last month; use of vaginal creams in the last 30 days; multiple pregnancy, regular use of alcohol or illicit drugs or use of medications that can interfere with sexual function. Eighty-seven patients fulfilled the selection criteria and were included in the study. The Sexual Quotient . Feminine Version (QS-F) questionnaire was used to assess sexual function. Student's t and χ² tests were used to compare differences between groups and p<0.05 was considered significant.
The mean gestational age of the participants was 34 weeks. There were no significant differences in the mean QS-F scores between groups (62.5 healthy vs 62.8 GDM women, p=0.9). Approximately half the participants (47 and 47.5% of the healthy and GDM women, respectively, p=0.9) had total scores up to 60, indicative of dysfunction in one of the assessed domains (desire, sexual satisfaction, arousal, orgasm, dyspareunia and vaginismus).
The prevalence of sexual dysfunction was high among women in the third trimester of pregnancy and did not differ significantly between healthy women and women with GDM.
Revista brasileira de ginecologia e obstetrićia: revista da Federação Brasileira das Sociedades de Ginecologia e Obstetrícia 05/2011; 33(5):219-24.
-
[show abstract]
[hide abstract]
ABSTRACT: Assess intra and interobserver reproducibility of three-dimensional power Doppler (3DPD) placental vascular indices in normal pregnancies between 26 and 35 weeks.
Thirty 3D volumes were captured by one observer and stored for analysis. Vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were calculated from the spherical placental tissue samples obtained through the automatic Virtual Organ Computer-aided AnaLysis (VOCAL). Two observers analyzed the stored volumes and calculated the indices and their findings were compared. Intraclass correlation coefficients (ICCs) were used to analyze intra and interobserver correlations. Data were analyzed using confidence intervals, reliability coefficients and Bland-Altman graphs with concordance limits.
All three indices had good intra and interobserver reproducibility. Intraobserver ICCs for the three indices were > 0.90. The FI had the highest ICC (0.99), the highest interobserver ICC (0.98) and the best concordance on the Bland-Altman graphs.
3DPD placental vascular indices obtained using the automatic sphere mode had a good intra and interobserver reproducibility for pregnancies between 26 and 35 weeks. The FI obtained the highest reproducibility scores.
Archives of Gynecology 02/2011; 283(2):213-7. · 0.91 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To assess a possible relation between proinflammatory mediators (IL-1R1, IL-12, IL-18, TLR-2, and TLR-4) gene polymorphisms and preeclampsia (PE).
Genotyping was performed on 109 preeclamptic patients and 174 healthy fertile women with at least two previous successful pregnancies (controls). χ(2) or Fisher's exact test were used to compare genotype frequencies. The control group included 174 pregnant women matched by race to the study group.
Genotypic and allelic distributions for all six polymorphisms were similar between the study and control groups. IL-1R1 (PstI, rs2234650): p = 0.82 ; IL-12 (+1188, rs3212227): p = 0.93; IL-18 (-137, rs187238): p = 0.74 ; IL-18 (-607, rs1946519): p = 0.22; TLR-2 (+2258, rs5743708): p = 0.97; and TLR-4 (+896, rs4986790): p = 0.23.
The analyzed gene polymorphisms are not associated with PE.
Hypertension in Pregnancy 01/2011; 30(3):338-46. · 1.69 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Diabetes mellitus (DM) is a complex disease, being one of the most prevalent diseases worldwide. As a consequence, pregnancy-associated diabetes is increasingly common. Given the numerous studies about the influence of diabetes on offspring of diabetic rat dams, the neurological outcome is of outmost importance. This paper aimed at evaluating the neurofunctional performance of young male offspring of rat dams with diabetes induced by streptozotocin. Diabetes was induced in Wistar female rats by streptozotocin administration, while control groups received vehicle injection. At two-month survival period, male offspring from each group were randomized to the water maze Morris test, in order to assess their neurofunctional status. There was no significant difference between the groups as assessed by the Morris water maze test for spatial reference task. Our results point to the need of further investigation on the offspring neurofunctional performance.
ISRN endocrinology. 01/2011; 2011:480656.
-
[show abstract]
[hide abstract]
ABSTRACT: The costimulatory molecules CD28, cytotoxic T-lymphocyte antigen-4 (CTLA-4) (cytotoxic T-lymphocyte-associated antigen-4) and inducible costimulator (ICOS) are believed to have a critical modulatory role in the immune response. However, few studies have been performed on the role of these immune regulatory molecules and their polymorphisms in women with preeclampsia (PE). The aim of our study was to evaluate the CTLA4 (+49 A/G) (rs 231775), CD28 (+17 T/C) (rs 3116496) and ICOS (-1564 T/C) (rs 4675378) gene polymorphisms in Brazilian women with PE. This case-control study included 130 patients with PE and 261 control women without any obstetric or systemic disorders. Genomic DNA was extracted from peripheral blood, and the polymorphism genotyping was performed by digesting the PCR products with the restriction endonucleases BbvI (CTLA-4), AfeI (CD28) and AluI (ICOS). Data were analyzed by χ(2) or Fisher's exact test; a P-value of <0.05 was considered as significant. There were significant differences in the ICOS genotype and allelic frequencies between the PE and control groups (P=0.01 and P=0.01, respectively). We found a significantly lower frequency of the ICOS (-1564) T allele in women with mild PE compared with the controls. There were no differences in the CTLA-4 (+49 A/G) and CD28 (+17 T/C) genotypes and allelic frequencies between the PE patients and controls. Our data suggest that PE is associated with ICOS, but is not associated with the CTLA-4 or CD28 gene polymorphisms.
Hypertension Research 12/2010; 34(3):384-8. · 2.58 Impact Factor
